Robert Watt

The applicant sought dispute resolution for a medical benefit of $1,346.49 for psychological services following a motor vehicle accident.

The parties consented to the application being dismissed without costs, as the applicant had a similar application before FSCO and wished to pursue that application instead.

The Tribunal dismissed the application without costs.

The applicant sought accident benefits following a motor vehicle accident involving their mother.

The respondent initially denied claims on the basis that the applicant was not an insured person, but later conceded this issue and agreed to pay for a psychological assessment.

The remaining issues at the hearing were entitlement to an in-home assessment, an award for unreasonable delay, and interest.

The Tribunal dismissed the claim for the in-home assessment because the treatment plan was never submitted to the Health Claims for Auto Insurance (HCAI) system.

The Tribunal also dismissed the claim for a special award, finding no unreasonable delay by the respondent.

However, the Tribunal ordered the respondent to pay interest on the psychological assessment from December 28, 2016, to May 8, 2017.

The applicant sought a rehabilitation benefit of $2,200 for a treatment and assessment plan following a motor vehicle accident.

The respondent denied the plan, arguing it was not reasonable and necessary.

The applicant argued the plan should be deemed approved because the respondent failed to respond within the required 10 days under section 38 of the SABS.

The Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, relying on an independent occupational therapy assessment that found no functional limitations.

Furthermore, although the respondent was late in responding, the applicant had not actually incurred the expenses, so there was no entitlement to payment under the deemed approval provisions.

The application was dismissed.

The applicant sought dispute resolution for a medical benefit of $1,346.49 for psychological services following a motor vehicle accident.

The parties consented to the application being dismissed without costs, as the applicant had a similar application before the Financial Services Commission of Ontario (FSCO) that they wished to pursue instead.

The Tribunal ordered the application dismissed without costs.

The applicant sought statutory accident benefits beyond the Minor Injury Guideline (MIG) limits, arguing that a pre-existing medical condition prevented her maximal recovery.

The applicant claimed funding for an in-home assessment and additional physiotherapy.

The Tribunal found that the applicant's injuries were predominantly minor and that she failed to provide compelling medical evidence of a pre-existing condition that would take her outside the MIG.

The Tribunal preferred the evidence of the independent medical examiner and the applicant's family doctor over the pain clinic records.

The application for benefits was dismissed.

The applicant, an Ontario resident, was injured in a motor vehicle accident in Michigan and sought to elect accident benefits under Michigan's Personal Injury Protection scheme rather than Ontario's Statutory Accident Benefits Schedule (SABS).

The respondent insurer denied the election because it was not a registered insurer under Michigan law.

The Tribunal found that the applicant did not meet the criteria to qualify as an insured in Michigan because the respondent had not filed a certification in compliance with Michigan law.

As the respondent had already paid the maximum medical and rehabilitation benefits available under the Ontario SABS, the application was dismissed.

The applicant withdrew his application for statutory accident benefits on the eve of the hearing.

The respondent brought a motion for costs, arguing that the applicant's claim lacked merit and the late withdrawal caused unnecessary expense.

The Tribunal dismissed the motion, finding that the withdrawal of an application, even at the last minute, does not meet the threshold of unreasonable, frivolous, vexatious, or bad faith behaviour required for a costs award under Rule 19.1.

The applicant withdrew his application for statutory accident benefits on the eve of the scheduled hearing.

The respondent brought a motion for costs, arguing that the applicant's late withdrawal and the lack of merit in the claim constituted unreasonable conduct.

The Tribunal dismissed the motion, finding that the withdrawal of an application alone, despite causing inconvenience and expense, does not meet the threshold of unreasonable, frivolous, vexatious, or bad faith conduct required for a costs award under Rule 19.1.

The applicant sought ongoing income replacement benefits following a motor vehicle accident.

The respondent had paid benefits until November 2014 but denied further entitlement.

The Tribunal found that the applicant's ongoing back pain was related to pre-existing mild degenerative changes and obesity, not the accident.

Medical evidence also suggested symptom embellishment.

The Tribunal concluded the applicant failed to prove a substantial inability to perform his pre-accident employment or a complete inability to engage in any suitable employment.

The application for ongoing benefits was dismissed.

The respondent's request for repayment of an overpayment was also dismissed as it was not properly raised at the case conference.